Navigating the Complexities of Lamotrigine and Hormonal Contraceptives
Dr. Danish and Philadelphia Integrative Psychiatry are committed to staying at the forefront of mental health research. This dedication ensures that our treatment plans are comprehensive and personalized. In this blog, we will explore the interaction between lamotrigine, a common psychiatric medication, and hormonal birth control—a topic of significant relevance to patient care. This discussion is informed by the study "Valproate and lamotrigine level variation with menstrual cycle phase and oral contraceptive use," published in Neurology.
The Interaction Between Lamotrigine and Hormonal Contraceptives
The research indicates that active oral contraceptive use leads to a significant reduction in serum levels of both valproate and lamotrigine. Specifically, there is a median decline of 23.4% for valproate and 32.6% for lamotrigine. Estrogen-containing oral contraceptives can reduce lamotrigine levels in the body by 41% to 64%, a reduction not seen with progestin-only contraceptives.
The Impact During the Pill-Free Week
During the pill-free week of a contraceptive cycle, lamotrigine levels can increase, potentially doubling, which may lead to adverse effects like dizziness and diplopia. This interaction necessitates careful dosage adjustments of lamotrigine for patients starting or stopping estrogen-containing oral contraceptives.
Considerations for Clinicians
The research emphasizes the need for clinicians to monitor medication levels and adjust dosages accordingly, especially when patients start or stop using estrogen-containing oral contraceptives. While lamotrigine slightly reduces progestin levels, it does not significantly impact the efficacy of oral contraceptives.
Alternative Contraception Methods
The potential benefits of alternative contraception methods that do not contain estrogen are also highlighted in the research. These alternatives may avoid the significant interactions seen with estrogen-containing contraceptives.
Getting in Touch with Dr. Danish and His Team
At Philadelphia Integrative Psychiatry, we specialize in diagnosing and treating conditions involving lamotrigine and hormonal contraceptives. Our holistic and integrative approach ensures that we consider all aspects of our patients' well-being in developing personalized treatment plans. If you or a loved one are seeking support for conditions related to these medications, please text or call 610-999-6414 to learn how we can help.
References
Herzog AG, et al. "Valproate and lamotrigine level variation with menstrual cycle phase and oral contraceptive use." Neurology. 2009 Mar 10;72(10):911-914. Link
Christensen J, et al. "Oral contraceptives induce lamotrigine metabolism: evidence from a double-blind, placebo-controlled trial." Epilepsia. 2007 Mar;48(3):484-9. Link
Wegner I, et al. "Lamotrigine kinetics within the menstrual cycle, after menopause, and with oral contraceptives." Neurology. 2009 Oct 27;73(17):1388-93. Link
Wegner I, et al. "Effect of oral contraceptives on lamotrigine levels depends on comedication." Acta Neurol Scand. 2014 Jun;129(6):393-8.Link
